CH 18: Digestion and Bowel Elimination

Question 1

effects of aging on GI health

Answer 1

Tongue atrophies _ decreased taste sensation
Changes in taste sensation _ xerostomia, smoking, meds, diseases
Decreased saliva production _ difficulty with swallowing
Thinning of oral mucosa & weak mastication muscles _ decreased chewing efficiency
Gingival recession _ loosens tooth support
Presbyesophagus: weak esophageal contractions _ weakness of LES
Decreased esophageal and stomach motility _ food stays in upper GI longer _ indigestion, aspiration
Decreased elasticity of stomach _ reduces amount of food the stomach can accommodate
Reduced HCl, pancreatic, and pepsin acid _ gastric irritation, decreased mineral absorption, altered digestion of fats
Meds, inactivity, decreased peristalsis, reduced food and fluid _ Increased constipation
Decreased sensory perception _ unnoticed signal for bowel elimination; incomplete bowel emptying
Decreased liver size (but function remains stable) & reduced hepatic blood flow
Pancreas will atrophy and become fibrotic _ Reduced pancreatic secretions

Question 2

GI health promotion in older adults

Answer 2

Increased fluid intake
Diet (fiber, fruits, veggies)
Establish a regular bowel pattern (preferably after breakfast)
Increased activity
Encourage complete bowel emptying
Astute assessment
Dental hygiene/Oral care

Question 3

interventions and education for oral health in older adults

Answer 3

Brush all tooth surfaces and tongue twice a day with soft-bristled toothbrush and fluoridated toothpaste
Floss between teeth daily
Avoid mouthwash with alcohol
Avoid swabsticks (dry oral mucosa)
Remove dentures at night and soak them in water
Clean dentures and gums before putting dentures in the mouth
Use sugar free candy & gum
Visit a dentist every 6 months
Fluoride treatments to improve tooth enamel

Question 4

dry mouth

Answer 4

Xerostomia

Question 5

causes of xerostomia

Answer 5

reduced saliva, meds, mouth breathing, altered cognition

Question 6

interventions for xerostomia

Answer 6

frequent mouth care
saliva substitutes
sipping water
sugarless candy/gum

Question 7

dental problems come from

Answer 7

wear and tear
increased brittleness
finances
poor diet
aging
meds

Question 8

dental problems can impact

Answer 8

food intake and appetite  malnutrition

Question 9

interventions for dental problems

Answer 9

regular dental care and exams
consider finances of dental care
brushing (not swabs)
daily flossing
denture care
avoid trauma & commercial mouthwash (dilute)
further evaluate all lesions

Question 10

causes of dysphagia in older adults

Answer 10

GERD, mechanical obstructions, and neuro disorders

Question 11

types of dysphagia

Answer 11

Can be oropharyngeal or esophageal with varying symptoms

Question 12

interventions for dysphagia

Answer 12

assessment of the symptoms
observe food intake
SLP
soft diet with thickened liquids
eat in upright position
ingest small bites at a time
verbal cues
monitor weight
suction available, etc.

Question 13

cause of hiatal hernia in older adults

Answer 13

Incidence increases with age; due to low-fiber diet

Question 14

symptoms of hiatal hernia

Answer 14

heartburn
dysphagia
belching
vomiting
regurgitation

Question 15

interventions of hiatal hernia

Answer 15

weight reduction
bland diet
5-6 small meals,
sleep on side position
meds
sit up1 hour after eating
don’t eat 2 hours before bed
smoking cessation
avoid irritants

Question 16

causes of esophageal cancer in older adults

Answer 16

connected to poor oral hygiene
smoking
alcohol
GERD (Barrett’s esophagus)

Question 17

symptoms for esophageal cancer

Answer 17

dysphagia,
weight loss,
thirst,
excessive salivation,
hiccups,
anemia,
chronic
bleeding

Question 18

interventions for esophageal cancer

Answer 18

Late diagnosis usually leads to surgical resection,
radiation,
chemo,
laser therapy,
photodynamic

Question 19

causes of peptic ulcer

Answer 19

meds that increase gastric secretions,
stress,
diet (spicy or citrus foods),
smoking,
alcohol/beer,
caffeine,
H. Pylori

Question 20

s/s of peptic ulcer in older adults

Answer 20

pain,
bleeding,
obstruction,
perforation

Question 21

interventions of peptic ulcer

Answer 21

address causes
meds
dietary changes

Question 22

causes of stomach cancer

Answer 22

Cigarette use
ethnicity
intake of red meats

Question 23

s/s of stomach cancer

Answer 23

anorexia,
epigastric pain,
weight loss,
anemia,
but can be insidious and mistaken for indigestion

Question 24

interventions for stomach cancer

Answer 24

surgery
partial or total gastrectomy

Question 25

diverticulosis vs diverticulitis

Answer 25

Diverticulosis occurs when small defects in the muscle of the wall of the large intestine or colon allow small pockets or pouches (diverticula) to form.
Diverticulitis is infection or inflammation of these abnormal pouches.
Together, these conditions are called diverticular disease

Question 26

diverticulosis causes

Answer 26

Common in older adults due to chronic constipation, obesity, hiatal hernia, low-fiber and fluid intake, and atrophy of muscle walls

Question 27

interventions for diverticulosis

Answer 27

increase in dietary fiber
weight reduction
avoidance of constipation

Question 28

causes of diverticulitis

Answer 28

Occurs frequently with older men; due to overeating, straining, alcohol, irritating foods

Question 29

interventions for diverticulitis

Answer 29

reducing infection,
rest,
providing nutrition,
relieving discomfort,
IV therapy,
low-residue diet,
NPO,
surgery – colectomy or temporary colostomy

Question 30

s/s of colorectal cancer

Answer 30

bloody stools,
bowel pattern changes,
unexplained weight loss,
anorexia,
nausea,
abdominal pain,
anemia

Question 31

colostomy as treatment for colorectal cancer

Answer 31

Can cause issues for older adults – threatens positive self-concept
Further separates them from society’s view of normal
Major adjustment with dependency
Reduced energy, arthritic fingers, slow movement, and poor eyesight contribute to care
Continued follow-up

Question 32

causes of chronic constipation

Answer 32

inactive lifestyle,
low fiber and fluids,
depression,
laxative abuse (damaging the nerves),
certain meds,
dulled sensation of defecation,
failure to allow complete bowel emptying

can lead to fecal impaction

Question 33

interventions for chronic constipation

Answer 33

high fiber diet,
fluid intake,
regular activity,
regular bowel elimination time (mornings),
meds (after all else fails)

Question 34

important nursing considerations for laxatives

Answer 34

provide thorough education on the use of laxatives in order to prevent abuse and avoid a fluid and electrolyte imbalance

Question 35

interventions for flatulence

Answer 35

knee-chest for pain,
avoid flatus producing foods,
sit upright after a meal,
increased activity

Question 36

what is an intestinal obstruction and what are the causes

Answer 36

Impairment of GI flow due to cancer, adhesions, hernias, diverticulitis, UC, paralytic ileus

Question 37

interventions of intestinal obstruction

Answer 37

must be prompt,
bowel decompression,
surgery;
maintain F&E balance and ensure comfort

Question 38

tx of fecal impaction

Answer 38

due to constipation
prevent constipation,
digital removal (consult facility),
enema,
hydrogen peroxide in a rectal tube

Question 39

most common individuals with fecal incontinence

Answer 39

institutionalized older adults with fecal impaction who are physically/cognitively impaired

Question 40

causes of fecal incontinence

Answer 40

decreased contractile strength,
impaired automaticity of sphincters,
loss of cortical control,
decreased space in colon

Question 41

interventions for fecal incontinence

Answer 41

assess for presence of impaction,
bowel retraining,
meds,
surgery

Question 42

symptoms of acute appendicitis for older adults

Answer 42

Severe pain occurring in younger people MAY NOT occur with older adults. Older adults have minimal, referred pain; minimal fever and absence of leukocytosis  delayed diagnosis and treatment

Question 43

interventions for acute appendicitis

Answer 43

prompt surgery

Question 44

primarily affected age groups for pancreatic cancer

Answer 44

70-79 years old

Question 45

symptoms of pancreatic cancer

Answer 45

Fever may not be present;
generalized symptoms (anorexia, weakness, weight loss, nausea/vomiting, dyspepsia, belching, diarrhea, constipation, obstructive jaundice)

Question 46

interventions for pancreatic cancer

Answer 46

surgery
poor prognosis

Question 47

biliary tract disease treatment

Answer 47

Cholelithiasis = gallstones
increase with age
shock wave lithotripsy (stones); surgery (cancer; poor prognosis)